Individual
JAMIE AZURE LILLIAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3230 E ROOSEVELT ST APT 221, PHOENIX, AZ 85008-5119
(602) 638-7974
Mailing address
3230 E ROOSEVELT ST APT 221, PHOENIX, AZ 85008-5119
(602) 638-7974
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
02/07/2022
Last updated
02/07/2022
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